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. 2019 Jul;7(7):14.
doi: 10.1007/s40137-019-0237-x. Epub 2019 May 15.

Resuscitation Strategies for Traumatic Brain Injury

Henry W Caplan  1 , Charles S Cox  1
Affiliations

Resuscitation Strategies for Traumatic Brain Injury

Henry W Caplan et al. Curr Surg Rep. 2019 Jul.

Abstract

Purpose of review: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality; however, little definitive evidence exists about most clinical management strategies. Here, we highlight important differences between two major guidelines, the 2016 Brain Trauma Foundation guidelines and the Lund Concept, along with recent pre-clinical and clinical data.

Recent findings: While intracranial pressure (ICP) monitoring has been questioned, the majority of literature demonstrates benefit in severe TBI. The optimal cerebral perfusion pressure (CPP) and ICP are yet unknown, but likely as important is the concept of ICP burden. The evidence for anti-hypertensive therapy is strengthening. Decompressive craniectomy improves mortality, but at the cost of increased morbidity. Plasma-based resuscitation has demonstrated benefit in multiple pre-clinical TBI studies.

Summary: The management of hemodynamics and intravascular volume are crucial in TBI. Based on recent evidence, ICP monitoring, anti-hypertensive therapy, minimal use of vasopressors/inotropes, and plasma resuscitation may improve outcomes.

Keywords: Lund Concept; cerebral perfusion pressure; intracranial hypertension; intracranial pressure; secondary brain injury; traumatic brain injury.

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Conflict of interest statement

Conflict of Interest Henry W. Caplan declares no potential conflicts of interest. Charles S. Cox holds equity and royalty interests in Cellvation Inc. as well as a sponsored research agreement and scientific advisory board position. Dr. Cox has sponsored research and holds a scientific advisory board position for CBR, Inc. He also sponsored research for Hope Bio, Inc., as well as Sponsored research and received equity/royalty interest from Coagulex, Inc.

Figures

Figure 1.
Figure 1.
Visualization of correlation between Glasgow Outsome Score (GOS) and average number of ICP insults per GOS category. Left adult cohort (n = 261). Right pediatric cohort (n = 99). Each color-coded point in the graph refers to a number of episodes of ICP, defined by a certain ICP intensity threshold (X-axis), and a certain duration threshold (Y-axis). Such an episode is called an ICP insult. The univariate correlation of each type of ICP insult (characterized by ICP intensity and duration thresholds) with outcome is color-coded. Dark red episodes mean that such ICP insults, on average, are associated with worse outcome (lower GOS categories); dark blue episodes mean that such ICP insults, on average, are associated with better outcome (higher GOS categories). The contour of zero correlation is highlighted in black, and is called the transition curve. Reproduced from Ref. (17), with permission.
Figure 2.
Figure 2.
(a) A schematic illustration of the cerebral capillary and the forces responsible for transcapillary fluid exchange in the uninjured brain with intact BBB. (b) The cerebral capillary and forces responsible for transcapillary fluid exchange in the injured brain, in which the capillaries are passively permeable for small solutes. Reproduced from Ref. (37), with permission.
See this image and copyright information in PMC

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